The Healthcare Policy Podcast ® Produced by David Introcaso

Due to the federal government’s ongoing failure to effectively address the climate crisis, over 50 subnational entities have been taking increasingly aggressive steps to mitigate carbon pollution. Recently, Vermont (VT) and New York (NY) passed legislation to hold the oil and gas industry financial responsible for extreme weather events supercharged by their greenhouse gas (GHG) emissions. (Eleven other states are presently working to do the same.) The VT law tallies up the financial damage and then determines proportional responsibility; NY identifies in advance a damage amount and then proportionally bills responsible fossil fuel companies. VT and NY’s legislation is based attribution science. Simply explained, the methodology attempts to measure to what extent anthropocentric warming caused by fossil fuel use of specific entities supercharges extreme weather events. Last month, Stanford’s Dr. Christopher Callahan and Dartmouth’s Dr. Justin Makin published, “Carbon Majors and the Scientific Case for Climate Liability in the journal “Nature.” The authors calculated the trillions of dollars in economic losses attributable to the extreme heat caused by emissions from individual companies or carbon majors. For example, emissions attributable to Chevron caused between $791 billion and $3.6 trillion in heat-related losses between 1991 and 2020. Drs. Callahan and Mankin’s April 24 “Nature” article is at: https://www.nature.com/articles/s41586-025-08751-3 (subscription is required).A summary of the article is freely available via “The Guardian,” at: https://www.theguardian.com/environment/2025/may/05/cost-of-emissions-from-five-major-australian-resource-companies-more-than-900bn-study-finds. Info on Dr. Callahan is at: https://profiles.stanford.edu/326897 and for Dr. Mankin, at: https://geography.dartmouth.edu/people/justin-s-mankin. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Despite the fact US healthcare has $7.6 trillion market cap and is beyond capital intensive, industry executives have been loathe to divest in fossil fuels. For example, per “The Lancet’s” 2023 and 2024 annual “Countdown on Health and Climate” reports, between 2008 and 2023 of the 1,613 institutions committed to divesting in fossil fuels, only 28 were healthcare institutions and since 2018 only one has committed to doing so. Among numerous other reasons why this is, to be polite, disturbing, if not evil, is because: fossil fuel investments substantially explain healthcare’s massive carbon footprint at over 600 MMT of CO2e annually; anthropocentric warming poses the greatest threat to human health; failure to divest make a mockery of the Hippocratic Oath; and, among other ironies of the 12 S&P 500 economic sectors the energy sector was the worst performer by far since 2010. Information regarding the First Do No Harm campaign, including their sign-on letter, is at: https://firstdonoharm.earth/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

US healthcare costs and spending are extreme made evident by the fact healthcare at a $5 trillion annually accounts for roughly half the global healthcare market. This reality led Princeton’s Nobel Prize Economist Angus Deaton to conclude in 2020, “the industry is a cancer at the heart of the economy.” Though healthcare costs are projected to rise 7 to 8%, this year, cost growth over the past 15 plus years plus has not on average exceeded GDP growth - made evident by the fact that while the 2020 Medicare Trustee report concluded the Medicare hospital trust fund would be bankrupt by 2026, the most recent report concluded 2036. Prof. Buntin’s recent writing on the topic, “The Value Zeitgeist, Considering the Slowdown in Healthcare Spending Growth,” coauthored by Harvard’s Ellen Meara and Dartmouth’s Carrie Colla, was published in “The New England Journal of Medicine” on April 12th. Prof Buntin’s recent publications are at: https://hbhi.jhu.edu/expert/melinda-buntin. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

At present, measles, one of the most contagious communicable diseases for which there is no treatment, disproportionately sickens - and kills - preschoolers. The outbreak is present today in 21 states ranging from Alaska to Vermont. As of last Friday, this year has already seen 607 confirmed cases, 72% of cases were among those age 5 to 19 and 97% of those infected were either unvaccinated or their vaccination status is unknown. For comparison, for five-year period ending in 2024 the average number of annual measles cases equaled 105.The measles, mumps, and rubella (MMR) vaccine is exceptionally effective and when immunization is greater than 95%, herd immunity is achieved. Having previously attained this percent measles was considered officially eliminated in the US in 2000. Achieving measles elimination was considered an historic public health achievement. Today however approximately 40 of states have vaccination rates below 95%. As a result, public health officials, for example in West Texas, expect the outbreak to continue for the remainder of this year, if not beyond.Concerning the federal government’s response this past Sunday when asked about the outbreak , President Trump stated, “It’s so far a fairly small number of people relative to what we’re talking about,” adding, “this is not something new.” Beyond cutting CDC staff and state funding to monitor infection/disease transmission, the White House is withdrawing the US from the World Health Organization (WHO) that in part managed a networks of labs, entirely funded by the US, to track measles cases around the world. HHS Secretary Robert Kennedy, a man with an anti-vaccination history, recently stated the measles vaccine is the “most effective way to prevent the spread” of the disease, however, he continues to frame vaccination as a personal choice and suggest the vaccine can cause just as much harm as the disease itself. Hours after making his “most effective” comment, the Secretary highlighted the work of doctors treating infected children with steroids and an antibiotic. The Secretary has also noted cod liver oil and Vitamin A as treatments. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

The Trump administration has made no secret it intends to aggressively enforce immigration laws, made evident by the recent arrest of a Columbia University grad student and green card holder on Columbia’s campus. Since the White House has repeatedly stated it intends to deport roughly all 12 million undocumented immigrants, this presents an immediate problem for healthcare providers who, in part, have legal and ethical obligations to all their patients. This is particularly true ironically for HHS-regulated Federal Qualified Health Centers (FQHCs) who serve 32 million largely racial/ethnic minorities who, because they are largely poor and medically disenfranchised, are disproportionately in need of healthcare. One day after assuming office in January the acting Department of Homeland Security rescinded decades of prior policy that essentially stated the federal government would not take immigration enforcement action in “protected areas” that included healthcare facilities - and schools like Columbia University. Ms. Smith’s most recent writing on the topic, “ICE in your Healthcare Facility? No Need to Freeze,” is at: https://www.dorseyhealthlaw.com/ice-in-your-healthcare-facility-no-need-to-freeze/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Two weeks after being sworn in, last Friday HHS Secretary Robert Kennedy announced, “effectively immediately, the [1971] Richardson Waiver is rescinded and is no longer policy of the Department.” He explained his decision by stating “the extra-statutory obligations of the Richardson Waiver impose costs on the Department and the public, are contrary to the efficient operation of the Department, and impede the Department’s flexibility to adapt quickly to legal and policy mandates. “ The waiver, issued by President Nixon’s HEW Secretary, Elliot Richardson, effectively meant HHS would use the 1946 Administrative Procedure Act’s “notice of proposed rule making” (NPRM) process broadly and its “good cause” exception sparingly. (The APA essentially governs the process by which federal agencies develop and issue regulatory rules.) Secretary Kennedy rescinded the waiver citing APA language that exempts rule making, effectively public input, from matters “relating to agency management or personnel or to public policy, loans, grants, benefits or contracts” and permits departments to forgo public comment for “good cause” or when the procedure is “impracticable, unnecessary or contrary to the public interest.” Though Secretary Kennedy’s decision will almost certainly be challenged in court, in the near term HHS can make significant, and now unquestioned, regulatory changes to, for example, the Medicare and Medicaid programs. Sec. Kennedy’s one page, March 3 Federal Register notice is at: https://www.govinfo.gov/content/pkg/FR-2025-03-03/pdf/2025-03300.pdf. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Last year was the first calendar year with a global mean temperature of more than 1.5°C above the 1850-1900 average. Since 90% of global warming is occurring in the ocean, due to the earth’s rising energy imbalance resulting from continuing and increasing GHG emissions, not surprisingly research published in “Environmental Research Letters” in late January concluded ocean temperatures for the 450 day period between April ’23 and July ’24 were the warmest ever. Ocean surface temperatures are now warming 40 times faster than 40 years ago. As I’ve noted in previous discussions with Prof. Abraham, because warming oceans/ocean heat content plays a fundamental role in our planet’s energy, water and carbon cycles, warming ocean temperatures disrupt marine life that substantially threaten the availability of food we eat and the oxygen we breathe.The “Environmental Research Letters” article, “Quantifying the Acceleration of Muti-decadal Global Sea Surface Warming Driven by Earth’s Energy Imbalance,” is at: https://iopscience.iop.org/article/10.1088/1748-9326/adaa8a/pdf. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Under the Biden administration the US once again became the world’s largest producer of oil and gas. Because all fossil fuels projects are politically constituted via permitting, etc., it is no surprise that of the nearly $7 trillion of fossil fuel investments since the 2015 Paris Accord, almost $2 trillion has been provided by six US banks including Citi. Cancer alley, the nickname for a stipe of largely Louisiana coastline, is home to over 200 petrochemical plants, refineries and ports. As the name implies, per the EPA, cancer alley residents are exposed to over ten times the level of health risks from resulting air pollution. A recent report by Hip Hop, Stand.earth and others, titled “Citi: Funding Fossil-Fueled Environmental Racism in the Gulf South,” documents Citi’s investment in moreover four liquified natural gas (LNG) export terminals, the GHG emissions they’ll emit and the resulting health harms they’ll inflict on moreover minoritized communities. As likely the frontline example of environmental racism should cause one to recall the prosecutor’s closing argument in the George Floyd case, “if you’re doing something that hurts somebody, and you know it, you’re doing it on purpose.” The report is at: Citi-Funding-Fossil-Fueled-Environmental-Racism-in-the-Gulf-South.pdf.Info on the Hip Hop Caucus is at: https://hiphopcaucus.org/.Info on Stand.earth is at: https://stand.earth/resources/citi-enviro-racism/Info on Rise St. James is at: https://risestjames.org/As for our failure to make any progress in addressing health equity see, e.g., this JAMA-published research in 2019: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2736934 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

To begin my 14th year podcasting . . . , per the Sabin Center for Climate Change Law at Columbia Unversity, as of last September there were 1,850 climate crisis-related cases filed in the US challenging climate policy under constitutional, federal statutory including securities and financial regulations, state law claims and under several other categories. Law suits have been and will continued to be filed for the simple reason Congressional lawmaking and state legislating have failed to legitimately address the climate crisis, i.e., reduce CO2e emissions. Ms. Rodgers, Deputy Director, US Strategy at Our Children’s Trust, a public interest law firm dedicated to securing children’s legal rights to a healthy climate, discusses the current state of Juliana v the US initially filed in 2015, the 2023 Held v Montana decision in favor of 16 young people and a favorable 2024 settlement agreement resulting form Navahine F in which Hawaii’s DOT agreed to move aggressively to achieve a net zero ground transporation system. Ms. Rodgers also discusses OCT’s ongoing Genesis v the EPA case and the current International Court of Justice effort to reach an advisory opinion regarding climate-related legal obligations. Listeners may recall I interviewed Ms. Rodgers regarding Juliana in February 2020 and most recently, or last June, I spoke again with Michael Burger, CEO of Columbia’s Sabin Center, regarding climate litigation generally. The Sabin Center’s litigation database is at: https://climatecasechart.com/.Our Children’s Trust is at: https://www.ourchildrenstrust.org/.Judge Josephine Staton’s January 2020 dissent in Juliana is at: https://cdn.ca9.uscourts.gov/datastore/opinions/2020/01/17/18-36082.pdf. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

After heart disease cancer is the leading cause of death in the US. Forty percent of Americans will be diagnosed with cancer in their lifetime. Timely diagnosis and treatment of cancer has always been a concern made worse by the COVID pandemic and the ongoing problem of un- and under-insurance. Another reason for concern is the increasing use of networked-based social media sites used to advertise bogus cancer cures, particularly to Generation Z, or those 27 or under, who increasing use social media sites as de facto search engines. Dr. Baker’s recent research reveals health disinformation is rife on TikTok via its “For You” algorithm that directs users to fake cures and conspiratorial content via primarily five themes including personal anecdotes, conspiracy theories and spiritual messaging. (Devoted listeners may recall I interviewed Harvard’s Dr. Susan Linn two yrs ago next month re: her 2022 book, “Who’s Raising the Kids?” a critique of the “kid tech” world’s pernicious influence on children.)Prof. Baker’s, article, “Link in Bio: Fake Cancer Cures, Radicalization and Disinformation on a Democratic Society,” is at: https://osf.io/preprints/socarxiv/pqs5e. Information regarding her most recent book, “Wellness Culture: How the Wellness Movement Has Been Use to Empower, Profit and Misinform,” is at: https://bookstore.emerald.com/wellness-culture.html.    Prof. Baker serves as Deputy Head of the Department of Sociology and Criminology and a Reader in Sociology at City St. George's, University of London. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com